直覺手術 (ISRG) 2024 Q2 法說會逐字稿

Thank you, everyone, for standing by, and welcome to the Intuitive second-quarter 2024 earnings release. (Operator Instructions) As a reminder, today's call is being recorded. I will now turn the call over to your host, Head of Investor Relations, Brian King. Please go ahead.

感謝大家的耐心等待，歡迎來到 Intuitive 2024 年第二季財報發布。 （操作員說明）謹此提醒，今天的通話正在錄音。現在我將把電話轉給主持人投資人關係主管布萊恩金 (Brian King)。請繼續。

Good afternoon, and welcome to Intuitive second-quarter earnings conference call. With me today, we have Gary Guthart, our CEO; Dave Rosa, our President; and Jamie Samath, our CFO.

下午好，歡迎參加 Intuitive 第二季財報電話會議。今天和我在一起的還有我們的執行長加里·古特特 (Gary Guthart)；戴夫·羅莎，我們的總裁；和我們的財務長 Jamie Samath。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K for the fiscal year ended December 31, 2023, and subsequent filings.

在我們開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性在我們向美國證券交易委員會提交的文件中進行了詳細描述，包括我們截至 2023 年 12 月 31 日的財年的最新 10-K 表格以及後續文件。

Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements. Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events Section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website.

我們的 SEC 備案文件可以透過我們的網站或 SEC 網站找到。投資者應注意不要過度依賴此類前瞻性陳述。請注意，本次電話會議將在我們網站直覺的投資者關係頁面下的「活動」部分進行音訊重播。今天的新聞稿和補充財務數據表已發佈到我們的網站上。

Today's format will consist of providing you with highlights of our second quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will introduce the call and provide an organization update. Dave will present the quarter's business and operational highlights. Jamie will provide a review of our financial results. Then I will discuss procedure and clinical highlights and provide our updated financial outlook for 2024. And finally, we will host a question-and-answer session. With that, I will turn it over to Gary.

今天的形式將包括向您提供我們今天早些時候宣布的新聞稿中所述的第二季度業績亮點，然後是問答環節。加里將介紹此次電話會議並提供組織最新情況。戴夫將介紹本季的業務和營運亮點。傑米將對我們的財務業績進行審查。然後我將討論程序和臨床要點，並提供我們最新的 2024 年財務展望。有了這個，我會把它交給加里。

Thank you for joining us today. The fundamentals of our business were healthy in the quarter with solid procedure growth and strong capital placements, resulting in healthy financial performance. In the quarter, we made good progress with all three of our system platforms, including taking our measured rollout of da Vinci 5 to our next phase, continuing to stabilize and supply and support of customer expansion and expanding da Vinci SP installs in Europe, while supporting SP procedure growth across regions. Some multi-port procedural headwinds continued from last quarter, and we will describe these later on the call.

感謝您今天加入我們。本季我們的業務基本面保持健康，業務成長穩健，資本配置強勁，從而實現了健康的財務業績。本季度，我們的所有三個系統平台都取得了良好進展，包括將達文西5 的穩步部署推進到下一階段，繼續穩定、供應和支援客戶擴展以及擴大歐洲的達文西SP 安裝量，同時支援SP流程跨區域成長。自上個季度以來，一些多端口程序方面的不利因素仍在繼續，我們將在稍後的電話會議中對此進行描述。

Before turning the time over to Dave, I'd like to thank Marshall Mohr, our prior CFO and outgoing Head of Global Business Services. Marshall will be taking his skills to pursuits outside of Intuitive in September this year as he approaches his next endeavor. I thank him on behalf of all of us for his outstanding stewardship at Intuitive for the past 18 years.

在將時間交給 Dave 之前，我要感謝我們前財務長兼即將離任的全球商業服務主管 Marshall Mohr。今年 9 月，Marshall 將把他的技能運用到 Intuitive 以外的領域，邁向他的下一個目標。我代表我們所有人感謝他過去 18 年來對 Intuitive 的出色管理。

We are pleased to announce that in addition to his role as CFO, Jamie will expand his responsibilities to leading our information technology and global facilities teams. I'll now turn the time over to Dave, who will take you through commercial and operational highlights in greater detail.

我們很高興地宣布，除了擔任財務長之外，傑米還將擴大其職責，領導我們的資訊技術和全球設施團隊。現在我將把時間交給戴夫，他將帶您更詳細地了解商業和營運亮點。

Thank you, Gary. Starting with procedures, we experienced solid growth in the quarter of nearly 17% compared with a strong Q2 2023, which reflected the return of patients post pandemic, cholecystectomy, colon resection, lung resection and foregut procedures led to global procedure growth. General surgery led US procedure growth in the second quarter, and outside the US, procedure growth was led by non urology procedures.

謝謝你，加里。從手術開始，與2023 年第二季度的強勁增長相比，我們在本季度經歷了近17% 的穩健增長，這反映出大流行後患者的回歸、膽囊切除術、結腸切除術、肺切除術和前腸手術導致了全球手術的成長。第二季度一般外科手術引領美國手術成長，而美國以外的手術成長則由非泌尿科手術引領。

Regional performance included strength in Europe led by Germany, the UK, and Italy. And in Asia, we have mixed market conditions, largely consistent with Q1. Brian will describe these dynamics later in the call Turning to capital, we placed 341 da Vinci systems in the quarter, of which 320 were multiport systems, including 70 da Vinci 5 system. Our teams installed 21 SP systems and 74 Ion systems in the quarter with solid capital placements in the US, Japan and India and pressure in Europe and China.

區域表現包括以德國、英國和義大利為首的歐洲地區的實力。在亞洲，我們的市場狀況好壞參半，與第一季基本一致。 Brian 將在稍後的電話會議中描述這些動態。我們的團隊在本季安裝了 21 個 SP 系統和 74 個 Ion 系統，在美國、日本和印度擁有穩固的資本配置，而在歐洲和中國則面臨壓力。

System utilization defined as procedures per installed clinical system per quarter grew 2% globally year over year for our multi-port platforms, lower than our historical trend, reflecting procedure strength a year ago due to patient backlog. Utilization for SP and Ion continue to grow in the double-digit range in the quarter.

我們的多端口平台的系統利用率（定義為每季度每個已安裝臨床系統的程序數）在全球範圍內同比增長了2%，低於我們的歷史趨勢，反映了一年前由於患者積壓而導致的程序強度。本季 SP 和 Ion 的利用率繼續以兩位數成長。

Turning to our finances, revenue growth of 14% in the quarter reflects solid procedure performance and strong capital placements. Product margins were above our expectations, reflecting a combination of cost reductions, fixed overhead leverage, and some one-time nonrecurring benefits. Operating expenses reflected planned leverage in our enabling functions. Jamie will take you through our finances in greater detail later in the call.

談到我們的財務狀況，本季營收成長 14%，反映出穩健的流程績效和強勁的資本配置。產品利潤率高於我們的預期，反映出成本降低、固定間接費用槓桿和一些一次性非經常性收益的綜合影響。營運費用反映了我們支援職能中的計畫槓桿。傑米將在稍後的電話會議中向您詳細介紹我們的財務狀況。

In Q2, we moved into the next phase of our rollout of da Vinci 5. Within the quarter, we placed 70 da Vinci 5 systems as the launch continues to progress in line with our plans. Customer feedback points to improvements in precision imaging, ergonomics, and integration, the combination of which customers indicate has way to overall efficiency improvements.

在第二季度，我們進入了 da Vinci 5 推出的下一階段。客戶回饋指出了精確成像、人體工學和整合方面的改進，客戶表示這三者的結合可以提高整體效率。

Both force feedback and case insights bring new capabilities and analytics to surgery. We are encouraged by early insights these capabilities are presenting and are working hard to improve production and supply for force feedback, instruments and smooth our computational pipelines and workflows for case insights. We expect these capabilities to be powerful and the maturity and evidence of impact to build over coming quarters.

力回饋和案例洞察都為手術帶來了新的功能和分析。我們對這些能力所呈現的早期見解感到鼓舞，並正在努力改善力回饋、儀器的生產和供應，並平滑我們的計算管道和工作流程以獲取案例見解。我們預計這些功能將非常強大，並將在未來幾季逐漸成熟並產生影響力。

We launch new products thoughtfully, centered around outstanding customer experiences as our customers pursue operational and clinical excellence. We continue monitoring several key metrics across our measured rollout of da Vinci 5 as we ramp our supply and respond to customer input. We expect our measured rollout to continue through the first half of 2025.

我們精心推出新產品，以卓越的客戶體驗為中心，因為我們的客戶追求卓越的營運和臨床。隨著我們增加供應並回應客戶的意見，我們將繼續監控達文西 5 的測量部署過程中的幾個關鍵指標。我們預計我們的謹慎部署將持續到 2025 年上半年。

Adoption of our digital products and services grew nicely in the quarter with routine use of My Intuitive app, expanding to nearly 14,000 surgeons and surgeons using Intuitive more than doubling versus a year ago. The long-term opportunity for computational tools is both significant and difficult. To recognize these benefits at scale requires a foundational infrastructure that includes robust curated data, secure data warehousing, and global privacy compliance.

隨著My Intuitive 應用程式的日常使用，我們的數位產品和服務的採用在本季度取得了良好的增長，使用Intuitive 的外科醫生和外科醫生擴大到近14,000 名，比一年前增加了一倍多。計算工具的長期機會既重要又困難。要大規模認識到這些優勢，需要一個基礎設施，其中包括強大的精選資料、安全的資料倉儲和全球隱私合規性。

Our digital ecosystem, including case insights, leverages this infrastructure and enables us to collaborate with customers on a global scale to identify meaningful insights. These insights enable customers to optimize their robotic programs and ultimately reduce time to proficiency and improve clinical outcomes. As we said before, validations take time and are worthy pursuit.

我們的數位生態系統（包括案例見解）利用此基礎設施，使我們能夠與全球範圍內的客戶合作，以發現有意義的見解。這些見解使客戶能夠優化他們的機器人程序，最終縮短熟練程度並改善臨床結果。正如我們之前所說，驗證需要時間並且值得追求。

Turning to Ion, our teams have made material progress resolving supply constraints on catheters and vision probes. Excellence in manufacturing at scale in this space is complex, and we continue to reinforce our capabilities. Our commercialization in Europe continues according to plan, and our teams are progressing towards commercialization in China.

談到 Ion，我們的團隊在解決導管和視覺探頭的供應限制方面取得了實質進展。在這個領域，大規模製造的卓越是複雜的，我們不斷增強我們的能力。我們在歐洲的商業化繼續按計劃進行，我們的團隊正在朝中國的商業化邁進。

Turning to SP, last week, we received FDA clearance for thoracic procedures. We will be measured in our thoracic indication launch as we work to build a robust training and proctoring network as well as bring stapling to our SP platform. In closing, we are committed to our 2024 priorities, supporting our measured launch of da Vinci 5 and our other new platforms by region, supporting surgeons' adoption of focused procedures, continuing to improve product quality and margins, and finally, improving productivity in those functions that benefit from global scale. I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

談到 SP，上週我們獲得了 FDA 的胸部手術許可。我們將在胸部適應症發布中進行測量，因為我們致力於建立強大的培訓和監考網絡，並將裝訂引入我們的 SP 平台。最後，我們致力於實現 2024 年的優先事項，支持按地區有序推出達文西 5 和其他新平台，支持外科醫生採用重點手術，繼續提高產品品質和利潤，最後提高這些領域的生產力受益於全球規模的功能。現在我將把時間交給傑米，他將帶您更詳細地了解我們的財務狀況。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis and will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

午安.我將在非 GAAP 或備考基礎上描述我們的業績亮點，並在稍後準備的發言中總結我們的 GAAP 業績。我們的預估結果與公認會計準則結果之間的對帳已發佈在我們的網站上。

Q2 da Vinci procedures grew 17%. The installed base of systems grew 14% to just over 9,200 systems and average system utilization increased by 2%, lower than long-term historical averages, reflecting procedure strength in Q2 last year as a result of patient backlog. US procedures grew 14%, driven by growth in general surgery. Bariatric procedures in the US declined in the mid-single digit range. US procedures grew 22%, reflecting strong growth in general surgery, gynecology, and thoracic procedures.

第二季達文西程式成長了 17%。系統安裝基數增加了 14%，達到略高於 9,200 個系統，平均係統利用率增加了 2%，低於長期歷史平均水平，反映出去年第二季度因患者積壓而導致的程序強度。在普通外科手術成長的推動下，美國手術量增加了 14%。美國的減肥手術數量下降了個位數。美國手術量成長了 22%，反映出一般外科、婦科和胸部手術的強勁成長。

With respect to capital performance, we placed 341 systems in the second quarter compared to 331 systems in Q2 of last year. In the US, we placed 149 systems in Q2 compared to 157 systems placed last year, reflecting in part lower trade-ins. US system placements in Q2 included 70 da Vinci 5 placements.

就資本績效而言，我們在第二季放置了 341 個系統，而去年第二季為 331 個系統。在美國，我們在第二季度放置了 149 個系統，而去年放置了 157 個系統，這在一定程度上反映了以舊換新的減少。第二季美國系統投放量包含 70 個達文西 5 投放量。

Given the planned hardware and software updates of da Vinci 5 in the second half of this year and continued focus on maturing manufacturing and expanding capacity, we expect the da Vinci 5 placements will be constrained through the first half of 2025. Outside the US, we placed 192 systems in quarter two compared with 174 systems last year.

鑑於達文西 5 計劃在今年下半年進行硬體和軟體更新，以及繼續專注於成熟製造和擴大產能，我們預計達文西 5 的投放量將在 2025 年上半年受到限制。季度投放了192 個系統，而去年為174 個系統。

Current quarter system placements included 71 into Europe, 41 into Japan, and 14 into China compared with 76 into Europe, 33 into Japan, and 16 into China in Q2 of last year. We also saw relatively strong placements in India as well as markets served by our distributors, including Australia.

當前季度的系統投放量包括歐洲 71 個、日本 41 個和中國 14 個，而去年第二季歐洲有 76 個，日本有 33 個，中國有 16 個。我們在印度以及我們的經銷商服務的市場（包括澳洲）也看到了相對強勁的佈局。

Placements in Europe reflect health system budget constraints as several European governments are resetting capital spending post pandemic. Second quarter revenue was $2 billion, an increase of 14% from last year. On a constant currency basis, revenue growth was 15%.

歐洲的安置反映了衛生系統預算的限制，因為一些歐洲政府正在疫情後重新調整資本支出。第二季營收為20億美元，比去年成長14%。以固定匯率計算，營收成長 15%。

Additional revenue statistics and trends are as follows. Leasing represented 51% of Q2 placements, relatively consistent with recent trends. However, given customer preference for our usage-based models in the US and the launch of da Vinci 5, we continue to expect the proportion of systems placed under lease arrangements to grow over time.

其他收入統計數據和趨勢如下。租賃佔第二季投放量的 51%，與近期趨勢相對一致。然而，鑑於美國客戶對我們基於使用的模型的偏好以及達文西 5 的推出，我們仍然預計租賃安排下的系統比例將隨著時間的推移而增長。

Q2 system average selling prices were $1.44 million as compared to $1.39 million last year. Higher year-over-year system ASPs reflected a higher mix of da Vinci 5 and lower trade-ins, partially offset by a higher mix of system placements in Japan with a weaker yen exchange rate and lower pricing in China.

第二季系統平均售價為 144 萬美元，去年為 139 萬美元。系統平均售價同比上升反映了達文西 5 的組合增加以及以舊換新的減少，但部分被日本系統配置組合增加、日元匯率走軟以及中國定價降低所抵消。

In Q2 of 2023, trade-ins represented 18% of total system placements as compared to 6% in Q2 of 2024. We recognized $28 million of lease buyout revenue in Q2 compared with $29 million last quarter and $12 million last year. Da Vinci instrument and accessory revenue per procedure was approximately $1,800, an increase of approximately $20 compared to last quarter.

2023 年第二季度，以舊換新佔系統總安置量的18%，而2024 年第二季度為6%。去年為1200 萬美元。每次手術的達文西儀器和配件收入約為 1,800 美元，比上季度增加約 20 美元。

The sequential increase in I&A per procedure is primarily a result of customer ordering patterns in the US Turning to our Ion platform, procedures grew 82% to approximately 23,200 procedures in the second quarter. During the quarter, we placed 74 Ion Systems compared to 59 last year and 70 last quarter.

每個程序的 I&A 環比增長主要是美國客戶訂購模式的結果。本季度，我們放置了 74 個 Ion Systems，去年為 59 個，上季為 70 個。

During Q2, we caught up with the remaining backlog of system placements as supply of catheters and vision probes continued to improve. The installed base of Ion Systems increased 56% year over year to 678 systems, of which 275 are under operating lease arrangements.

在第二季度，隨著導管和視覺探頭的供應持續改善，我們趕上了剩餘的系統放置積壓工作。 Ion Systems 的安裝基數年增 56%，達到 678 套系統，其中 275 套採用營業租賃安排。

Second quarter SP procedure growth accelerated to 74% with strong growth in Korea and the US and early-stage growth in Japan in Europe. 21 of the systems placed in the quarter were SP systems, including 10 systems placed in Europe. The SP installed base grew 56% from the year ago quarter to 222 systems.

第二季 SP 程序成長加速至 74%，其中韓國和美國成長強勁，日本和歐洲早期成長。本季部署的系統中有 21 個是 SP 系統，其中 10 個系統部署在歐洲。 SP 安裝基數較去年同期成長 56%，達到 222 個系統。

Moving on to the rest of the P&L, Pro forma gross margin for the second quarter of 2024 was ahead of our expectations at 70% compared with 68.5% for the second quarter of 2023 and 67.6% last quarter. Second quarter pro forma gross margin reflected certain one-time benefits that we do not expect to recur. Excluding these onetime benefits, pro forma gross margin would have been 69.5%.

繼續看損益表的其餘部分，2024 年第二季的預期毛利率為 70%，超出了我們的預期，而 2023 年第二季為 68.5%，上季為 67.6%。第二季度預計毛利率反映了某些我們預計不會再次出現的一次性收益。排除這些一次性收益，預計毛利率將為 69.5%。

The sequential improvement in pro forma gross margin primarily reflects lower inventory reserves, cost reductions in certain purchase components, lower freight rates, and leverage of fixed overhead. In accordance with our plans, product margins for our Ion and SP platforms improved in the quarter and will remain a focus for our business unit and manufacturing teams over the medium term. As a reminder, given recent and ongoing capital investments, we expect increased depreciation expense in the second half and a significant increase in depreciation expense starting in Q1 of 2025.

預計毛利率的環比改善主要反映了庫存儲備的降低、某些採購組件成本的降低、運費的降低以及固定管理費用的槓桿作用。根據我們的計劃，我們的 Ion 和 SP 平台的產品利潤率在本季度有所改善，並且在中期內仍將是我們業務部門和製造團隊的關注重點。提醒一下，考慮到最近和正在進行的資本投資，我們預計下半年折舊費用將增加，並從 2025 年第一季開始折舊費用將大幅增加。

Second quarter pro forma operating expenses increased 11% compared with last year, reflecting the ongoing benefit of planned leverage in enabling functions. We continue to prioritize investments in R&D to fund innovation and future growth.

第二季度預計營運費用比去年增長 11%，反映了計劃槓桿在支援功能方面的持續效益。我們繼續優先考慮研發投資，為創新和未來成長提供資金。

During the quarter, we added approximately 550 employees, of which roughly half were in our manufacturing operations to support growth in customer demand. Pro forma other income was $79.4 million for Q2, higher than $72.5 million in the prior quarter, primarily due to higher interest income.

本季度，我們增加了約 550 名員工，其中約一半在製造業務中，以支援客戶需求的成長。第二季預計其他收入為 7,940 萬美元，高於上一季的 7,250 萬美元，主要是由於利息收入增加。

Our pro forma effective tax rate for the second quarter was 22.5%, consistent with our expectations. Second quarter 2024 pro forma net income was $641 million or $1.78 per share compared with $507 million or $1.42 per share for the second quarter of last year.

我們第二季的預期有效稅率為 22.5%，與我們的預期一致。 2024 年第二季預計淨利為 6.41 億美元，即每股 1.78 美元，去年第二季為 5.07 億美元，即每股 1.42 美元。

I will now summarize our GAAP results. GAAP net income was $527 million or $1.46 per share for the second quarter of 2024 compared with GAAP net income of $421 million or $1.18 per share for the second quarter of 2023. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee equity plans, employee stock-based compensation, amortization of intangibles, litigation charges and gains and losses on strategic investments.

現在我將總結我們的 GAAP 結果。 2024 年第二季的GAAP 淨利為5.27 億美元，即每股1.46 美元，而2023 年第二季的GAAP 淨利為4.21 億美元，即每股1.18 美元。在我們的網站上進行了概述和量化。

We ended the year with cash and invest -- we ended the quarter with cash and investments of $7.7 billion, higher than the $7.3 billion we ended last quarter. The sequential increase in cash and investments reflected cash generated from operating activities, partially offset by capital expenditures of $309 million. And with that, I would like to turn it over to Brian.

我們以現金和投資結束了這一年——本季結束時我們的現金和投資為 77 億美元，高於上一季結束時的 73 億美元。現金和投資的連續成長反映了經營活動產生的現金，部分被 3.09 億美元的資本支出所抵銷。說到這裡，我想把它交給布萊恩。

Thank you, Jamie. Overall, second quarter procedure growth was 17% compared to 22% for the second quarter of 2023 and 16% last quarter. In the US, second-quarter 2024 procedure growth was 14% compared to 19% for the second quarter of 2023 and 14% last quarter.

謝謝你，傑米。整體而言，第二季程式成長率為 17%，而 2023 年第二季為 22%，上一季為 16%。在美國，2024 年第二季的手術成長率為 14%，而 2023 年第二季為 19%，上一季為 14%。

Second quarter growth was led by procedures within general surgery with strength in cholecystectomy and foregut procedures and also thoracic procedures. Bariatric procedure growth declined in the mid-single digit range.

第二季的成長主要由一般外科手術帶動，其中膽囊切除術、前腸手術以及胸部手術表現強勁。減重手術的成長在中個位數範圍內下降。

Outside of the US second-quarter procedure volume grew 22% compared with 28% for the second quarter of 2023 and 20% last quarter. Growth was led by non-urology procedures with strength in colon resection, hysterectomy, and lung resection procedures.

美國以外第二季的手術量增加了 22%，而 2023 年第二季為 28%，上一季為 20%。成長主要由非泌尿外科手術帶動，其中結腸切除術、子宮切除術和肺切除術佔優勢。

In Europe, second-quarter growth continued to be led by procedures beyond urology, primarily from general surgery and gynecology procedure categories. Germany, the UK, and Italy procedure performance led the region with each experiencing strong growth in colon and rectal resection, hysterectomy and other general surgery procedures.

在歐洲，第二季的成長繼續由泌尿科以外的手術帶動，主要來自普通外科和婦科手術類別。德國、英國和義大利的手術表現在該地區處於領先地位，結腸和直腸切除術、子宮切除術和其他普通外科手術均出現強勁增長。

In Asia, growth in the second quarter was led by Japan and India, while growth in China was stressed and Korea procedure growth continued to be impacted by physician strikes. In Japan, overall procedure growth was solid, with continued strength in colon and rectal resection, gynecology, and lung resection procedures.

在亞洲，第二季的成長由日本和印度引領，而中國的成長受到壓力，韓國手術成長繼續受到醫生罷工的影響。在日本，整體手術成長強勁，結腸和直腸切除、婦科和肺切除手術持續強勁。

In India, while still in the early stage of adoption, we saw strength in gynecology and general surgery procedures, particularly with growth in hysterectomy, cholecystectomy, and hernia repair. China procedure growth was lower than prior period averages when compared to the same quarter a year ago, which experienced a recovery in procedures impacted by COVID. System utilization remained strong, while capital placements continued to be impacted by delayed tenders and emerging domestic robotic systems.

在印度，雖然仍處於採用的早期階段，但我們看到了婦科和普通外科手術的優勢，特別是子宮切除術、膽囊切除術和疝氣修復的增長。與去年同期相比，中國的手術成長低於去年同期平均水平，受新冠疫情影響的手術已恢復。系統利用率仍然強勁，而資本配置繼續受到延遲招標和新興國內機器人系統的影響。

Now, turning to the clinical side of our business. Each quarter on these calls, we highlight certain recently published studies that we deem to be notable, however, to gain a more complete understanding of the body of evidence, we encourage all stakeholders to thoroughly review the extensive detail of scientific studies that have been published over the years.

現在，轉向我們業務的臨床方面。每個季度，我們都會在這些電話會議上強調最近發表的某些我們認為值得注意的研究，但是，為了更全面地了解證據體系，我們鼓勵所有利益相關者徹底審查已發表的科學研究的廣泛細節這些年來。

Earlier this year, Dr. Jiang and team from the Guangzhou university of Chinese Medicine published a systematic review and meta-analysis in the International Journal of Surgery that looked at open, laparoscopic, and robotic-assisted surgery approaches to rectal cancer management. This meta-analysis covered 56 studies and included over 25,000 patients, of which approximately 11,000 patients received robotic-assisted surgery over 13,000 patients laparoscopic surgery and over 390 patients received open surgery.

今年早些時候，廣州中醫藥大學的江博士和團隊在《國際外科雜誌》上發表了一篇系統性回顧和統合分析，研究了開放式、腹腔鏡和機器人輔助手術治療直腸癌的方法。這項統合分析涵蓋了 56 項研究，納入了超過 25,000 名患者，其中約 11,000 名患者接受了機器人輔助手術，超過 13,000 名患者接受了腹腔鏡手術，超過 390 名患者接受了開腹手術。

When compared to the control group of both laparoscopic and open procedures, patients undergoing a robotic-assisted approach had an approximately two days shorter length of stay. Specifically when compared to lap, the robotic-assisted group was associated with a 1.7-day shorter length of stay.

與腹腔鏡和開放手術的對照組相比，接受機器人輔助手術的患者的住院時間大約縮短了兩天。具體而言，與 lap 相比，機器人輔助組的住院時間縮短了 1.7 天。

Relative to open surgery, the length of stay was 5.5 days shorter. The robotic-assisted approach was also demonstrated a protective effect for converting to an open procedure with 61% lower odds of conversion associated with robotics relative to the laparoscopic approach.

相對於開放性手術，住院時間縮短了5.5天。機器人輔助方法也被證明對轉換為開放性手術具有保護作用，與腹腔鏡方法相比，與機器人技術相關的轉換幾率降低了 61%。

Finally, when compared to the laparoscopic and open control group, the robotic assisted approach showed less estimated blood loss, approximately 40% lower odds of urinary retention, and when compared to open a higher number of harvested lymph nodes. The authors concluded quote, the robotic approach emerges as the most favorable option for managing rectal cancer when compared to open laparoscopic and transitional techniques as it delivers the finest blend of oncological, functional, and patient recovery outcomes.

最後，與腹腔鏡和開腹對照組相比，機器人輔助方法顯示估計失血量較少，尿瀦留的幾率降低約 40%，與開腹手術相比，收穫的淋巴結數量更多。作者總結道，與開放式腹腔鏡和過渡技術相比，機器人方法成為治療直腸癌的最有利選擇，因為它提供了腫瘤學、功能性和患者復原結果的最佳組合。

The digital interface of surgical robots enables a shift in the paradigm of surgical training, facilitating shorter learning curves that are more comprehensive and notably reducing the morbidity and mortality associated with them, end quote.

手術機器人的數位介面實現了手術訓練模式的轉變，促進更短的學習曲線，更全面，並顯著降低與之相關的發病率和死亡率，引用結束。

I will now turn to our financial outlook for 2024. Starting with procedures. On our last call, we forecasted full-year 2024 procedure growth within a range of 14% and 17%. We are now narrowing our forecast and expect full year 2024 procedure growth of 15.5% to 17%. The low end of the range assumes further softening in bariatric procedures, along with increasing headwinds in Asia from prolonged physician strikes in Korea and in China from delayed tenders and emerging domestic robotic systems impacting capital placements and therefore, procedure growth.

我現在將談談我們 2024 年的財務展望。在上次電話會議中，我們預測 2024 年全年手術成長將在 14% 至 17% 的範圍內。我們現在正在縮小預測範圍，預計 2024 年全年流程成長率為 15.5% 至 17%。該範圍的低端假設減肥手術進一步軟化，同時韓國和中國的醫生長期罷工、招標延遲以及新興的國內機器人系統影響資本配置，從而影響手術增長，亞洲的阻力也越來越大。

At the high end of the range, we assume bariatrics stabilizes at current quarter rates and headwinds in Korea and China do not get worse. Turning to gross profit, we are increasing our pro forma gross profit margin to be within 68.5% and 69% of net revenue. Our actual gross profit margin will vary quarter to quarter, depending largely on product, regional and trade-in mix, and the impact of new product introductions.

在該範圍的高端，我們假設減肥治療穩定在當前季度的水平，韓國和中國的逆風不會變得更糟。談到毛利，我們將預期毛利率提高到淨收入的 68.5% 和 69% 以內。我們的實際毛利率將隨季度而變化，主要取決於產品、區域和以舊換新的組合以及新產品推出的影響。

Turning to operating expenses, we are lowering our guidance for pro forma operating expense growth to be between 10% and 13%. We are refining our non-cash stock compensation expense to range between $680 million to $700 million in 2024. We are narrowing our guidance for other income, which is comprised mostly of interest income to total between $300 million and $320 million in 2024.

談到營運費用，我們將預期營運費用成長指引下調至 10% 至 13% 之間。我們正在將非現金股票補償費用細化至2024 年6.8 億美元至7 億美元之間。 3.2 億美元之間。

With regard to capital expenditures, we continue to estimate a range of $1 billion to $1.2 billion, primarily for planned facility construction activities. With regard to income tax, there is no change to our guidance of 2024 pro forma income tax rate to be between 22% and 24% of pretax income. That concludes our prepared comments. We will now open the call to your questions.

關於資本支出，我們繼續估計在 10 億至 12 億美元之間，主要用於計劃的設施建設活動。關於所得稅，我們對 2024 年備考所得稅率的指導沒有變化，即稅前收入的 22% 至 24% 之間。我們準備好的評論到此結束。我們現在將開始電話詢問您的問題。

(Operator Instructions) Larry Biegelsen, Wells Fargo.

（操作說明）Larry Biegelsen，富國銀行。

Good afternoon. Thanks for taking the question and congratulations on a really nice quarter here. Of course, I have to start with the da Vinci 5, really strong start here, 70 placements. I heard the comments about being constrained through the second half of 2025, but da Vinci 5 was almost half of the US placements. So it looks like a strong launch.

午安.感謝您提出問題，並祝賀您度過了一個非常美好的季度。當然，我必須從達文西 5 開始，這裡的起步非常強勁，有 70 個展示位置。我聽到關於 2025 年下半年受到限制的評論，但達文西 5 幾乎占美國投放量的一半。所以這看起來像是一個強而有力的發布。

So how should we think about the ramp in da Vinci 5 placements in the second half? And how should we think about trade-ins going forward, which are probably a little lower than I expected this quarter in the US. And I had one follow-up.

那我們該如何看待《達文西5》下半年的排名上升呢？我們應該如何考慮未來的以舊換新，這可能比我本季在美國的預期要低一些。我有一個後續行動。

Hey, Larry, this is Jamie. I would say, for the second half of '24, you should expect DV5 placements in the US to increase modestly quarter to quarter and that in part reflects the fact that we do have this hardware-software update that we described. And so you have to organize how you do that build plan through the factory carefully for that update.

嘿，拉里，這是傑米。我想說，在 24 年下半年，您應該預計 DV5 在美國的投放量將逐季小幅增長，這在一定程度上反映了我們確實進行了我們所描述的硬體軟體更新這一事實。因此，您必須仔細組織如何透過工廠執行該建置計劃以進行更新。

And we said we'd be in a measured rollout through the first half of 2025. With respect to how we've organized the measured rollout of DV. five, we've really focused the sales force on looking to place da Vinci 5 for incremental capacity for our customers versus the trade-in cycle. I think we'd rather get to a broad launch where we essentially have unconstrained supply relative to demand before we look at the trade-in cycle.

我們說過，我們將在 2025 年上半年進行有計劃的部署。第五，我們真正讓銷售人員專注於尋找達文西 5，以便在以舊換新周期中為我們的客戶提供增量容量。我認為，在我們考慮以舊換新周期之前，我們寧願先進行廣泛的發布，相對於需求而言，供應基本上不受限制。

Just a couple of comments on the trade-in cycle, I think I wouldn't expect a trade-in cycle to suddenly emerge and take off quickly. I think what we've seen in the past is that that's progressive and over multiples of years. And in part that will reflect the fact, many customers will want to evaluate da Vinci 5. They'll want to see evidence grow over time in terms of its capability and feature set. And of course, on their desire for da Vinci 5 will depend on their individual program and what they see the value of that in part given the higher pricing or lease costs for da Vinci 5.

關於以舊換新周期的一些評論，我想我不會期望以舊換新周期會突然出現並迅速起飛。我認為我們過去所看到的是，這是進步的，並且持續了好幾年。這在一定程度上反映了一個事實，即許多客戶希望評估達文西 5。當然，他們對 da Vinci 5 的渴望將取決於他們的個人計劃以及他們所看到的價值，部分考慮到 da Vinci 5 的定價或租賃成本較高。

That's very helpful. And then I wanted to ask about China. You mentioned that a couple of times on the call today. We recently saw a new stimulus announced there. And my question is -- and you've talked about the anti-corruption initiative. Is that still having an impact? And how are you guys thinking about the new stimulus that was announced that will help drive placements. Thanks for taking the question.

這非常有幫助。然後我想問中國的情況。您在今天的電話會議上多次提到這一點。我們最近看到那裡宣布了一項新的刺激措施。我的問題是──你已經談到反腐敗倡議了。那還有影響嗎？你們如何看待已宣布的有助於推動安置的新刺激措施。感謝您提出問題。

And Larry, it's Dave. Answering the second part of your question, first around the stimulus. In talking to our teams, we don't see that it's going to have a material impact on the placements of systems or an impact on the quota.

拉里，是戴夫。回答你問題的第二部分，先圍繞著刺激因素。在與我們的團隊交談時，我們認為這不會對系統的佈局或配額產生重大影響。

With respect to the operating environment of China, the anti-corruption that you referenced, there's no question that the operating environment remains challenging. The health system in China is rebasing around the economics in medtech. I think that's clear across the industry.

就中國的經營環境，你提到的反貪腐而言，毫無疑問，經營環境仍然充滿挑戰。中國的衛生系統正在圍繞醫療技術經濟學進行重新調整。我認為這在整個行業中都是顯而易見的。

On the placement side, customers are continuing to value our offerings clearly. And we are seeing, as you know, the emergence of domestic systems. And so in spite of those challenges and everything that's going on in the environment in China, we're still seeing double-digit growth in procedures. So we remain confident and look forward to continuing our investments and focus on China.

在安置方面，客戶繼續明確地評估我們的產品。如您所知，我們正在看到國內系統的出現。因此，儘管存在這些挑戰以及中國環境中發生的一切，我們仍然看到手術量有兩位數的增長。因此，我們仍然充滿信心並期待繼續投資並專注於中國。

Thanks for taking the questions, guys.

謝謝你們提出問題，夥伴們。

Travis Steed, Bank of America.

特拉維斯·斯蒂德，美國銀行。

Congrats on the good quarter. Wanted to maybe if there's any way you can help us understand the demand side of the DV5 equation. I know we're in a constrained rollout, but 47% of the placements in the US were DV5 this quarter.

恭喜季度表現良好。希望您能以任何方式幫助我們了解 DV5 方程式的需求方。我知道我們的推出受到限制，但本季美國 47% 的展示位置是 DV5。

And then are there any way to rank order some of the factors you need to mark off and check off the list to get the full launch. Heard the software-hardware upgrade, but I assume there's some other variables to consider as well.

然後，有沒有什麼方法可以對您需要標記和核對清單的一些因素進行排序，以實現全面啟動。聽說了軟體硬體升級，但我認為還需要考慮一些其他變數。

Yeah, hey, Travis. It's Dave. Again, it's a couple of the factors that we've discussed in the past. And it's really three primary areas. One is making sure that we are maturing our supply chain and our manufacturing capacity so that we're again able to get to the quality, to the cost of the yields that we expect as we approach a broad launch.

是的，嘿，崔維斯。是戴夫。同樣，這是我們過去討論過的幾個因素。這實際上是三個主要領域。一是確保我們的供應鏈和製造能力不斷成熟，以便我們在接近廣泛發佈時能夠再次達到我們預期的品質和產量成本。

The second part is what Jamie described around the software and hardware update where we're trying to get that integrated into our systems and balancing the factory output. And then the third thing is listening to our customers. And so as these placements happen, we're listening to our customers and responding to their feedback. And we'll be releasing some software updates along the way here in order to respond to that feedback. And so we want to get that in place before we get to broad launch.

第二部分是傑米圍繞軟體和硬體更新所描述的，我們試圖將其整合到我們的系統中並平衡工廠輸出。第三件事是傾聽客戶的意見。因此，當這些展示位置發生時，我們正在傾聽客戶的意見並回應他們的回饋。我們將在此過程中發布一些軟體更新，以回應這些回饋。因此，我們希望在廣泛發布之前將其落實到位。

Perhaps I would just add, your question -- part of your question is on the demand side. And I would say that in the early phase of a launch, you have a tendency to see early adopters look for the latest technology and all the -- also the larger institutions, the large IDNs. And so you have to give it some time to see the full set of customers in terms of what the interest will be in the segments of customers.

也許我想補充一點，你的問題——部分問題是關於需求方面的。我想說的是，在發布的早期階段，您傾向於看到早期採用者尋找最新的技術和所有的技術——還有更大的機構、大型 IDN。因此，您必須給它一些時間來了解整個客戶群，並了解細分客戶群的興趣。

Again, we'll look for evidence to build over time -- for customers' belief to build over time. And so you probably need some time to see the full set of customers in terms of for the full picture of demand for da Vinci 5 is. And again, that takes some time. Da Vinci 5 is a platform. As we did with Xi, we'll invest in over time. And so you build a set of capabilities also overtime.

同樣，我們將尋找隨著時間的推移而建立的證據——讓客戶的信念隨著時間的推移而建立。因此，您可能需要一些時間來了解全套客戶對達文西 5 的需求的全貌。再說一次，這需要一些時間。達文西5是一個平台。正如我們對習近平所做的那樣，我們將隨著時間的推移進行投資。因此，你也會隨著時間的推移建立一套能力。

That's helpful. And Jamie, maybe on the gross margin side, very strong and only one-time was 50 basis points was kind of under and the pressure. Maybe initially gross margins would be a little lighter with DV5. Just can you elaborate on the strength and margins this quarter?

這很有幫助。傑米（Jamie），也許在毛利率方面，非常強勁，而且只有一次是 50 個基點，有點壓力。也許 DV5 最初的毛利率會低一些。您能詳細說明一下本季的實力和利潤嗎？

Yeah, I would just say that we described from a sequential basis what drove the improvement quarter on quarter. It was lower inventory reserves. Our teams did an outstanding job with respect to component cost performance with our suppliers and in the logistics area. And that came in earlier than we expected.

是的，我只想說，我們按順序描述了推動季度改善的因素。庫存儲備較低。我們的團隊在供應商和物流領域的組件成本績效方面做得非常出色。這比我們預期的還要早。

Those are a set of teams that for a couple of years had been working on supply because of COVID and the pandemic. And what happened in terms of supply constraints and those teams in more recent periods have refocused on cost reductions. And we saw that come in early. And so we were really pleased to see that.

由於新冠疫情和大流行，這些團隊多年來一直致力於供應工作。供應限制方面發生的情況以及這些團隊在最近一段時間內重新專注於降低成本。我們看到這一點很早就出現了。所以我們很高興看到這一點。

So great performance in the quarter. You saw us improve the guidance for the year. I would say if we -- as we look at the second half, you will see increased depreciation, as I described. You will see a high proportion of the revenue be new products, da Vinci 5 and Ion and SP.

本季的表現非常出色。您看到我們改進了今年的指導。我想說，如果我們觀察下半年，你會看到貶值增加，正如我所描述的。您將看到新產品、da Vinci 5 以及 Ion 和 SP 佔收入的很大一部分。

In Q2, all of the 70 da Vinci 5 placements, only 11 of them were purchase arrangement. So a muted effect in terms of gross margin in the quarter. The other placements are operating leases, where you see the economics play out over time.

第二季度，達文西5的70個投放中，只有11個是購買安排。因此，本季毛利率的影響不大。其他安置是經營租賃，隨著時間的推移，您會看到經濟效果。

Great. Thanks a lot.

偉大的。多謝。

Robbie Marcus, JP Morgan.

羅比馬庫斯，摩根大通。

Great. Thanks and I'll add congratulations on a very solid quarter here. I wanted to ask about the feedback in the field. You talked about in the script a bit. We've all talked to doctors and have heard from them. I'd love to hear from you both what the physicians are saying, but also what the institutions are saying.

偉大的。謝謝，我還要恭喜這個季度的表現非常出色。我想詢問一下現場的回饋。你在劇本裡談到了一些。我們都與醫生交談過並聽取了他們的意見。我很想聽聽你們醫生的說法以及機構的說法。

Clearly, demand is there, 70 units this fast is really strong. But what's the pushback, if any, for centers? How do they feel about the ability to drive better economics and faster procedures and better outcomes with da Vinci 5 and the feedback so far from the physicians?

顯然，需求是存在的，如此快速的 70 台確實很強勁。但對於中鋒來說，如果有的話，阻力是什麼？他們對達文西 5 推動更好的經濟效益、更快的手術和更好的結果的能力以及迄今為止醫生的反饋有何看法？

Yeah, Rob, maybe I'll start. This is Dave. Just starting with some of the feedback that we've discussed before, you look at what customers are immediately appreciating and some of the things you would expect around ergonomics, increases in precision and vision, the head in UI, onscreen graphics and other things.

是的，羅布，也許我會開始。這是戴夫。從我們之前討論過的一些反饋開始，您可以了解客戶立即欣賞的內容以及您期望的一些關於人體工學、精度和視覺的提高、用戶界面中的頭部、屏幕圖形和其他方面的內容。

And so taken together, each one of those features are leading to some efficiency gains, in particular in console time. And that has been noticed across the customer base. And I think that's where we're starting -- we're hearing a little bit about what can that mean in terms of adding a procedure a day, increasing utilization of the system. And so that's what both our surgeon customers and our executive customers are noticing as a result of their investment in da Vinci 5.

綜合來看，這些功能中的每一項都帶來了一定的效率提升，特別是在控制台時間上。整個客戶群都注意到了這一點。我認為這就是我們開始的地方 - 我們聽到了一些關於每天添加一個程式、提高系統利用率意味著什麼的資訊。這就是我們的外科醫生客戶和高階主管客戶因投資達文西 5 而注意到的結果。

Some of the other features, Case Insights, Force Feedback, we're excited to work with customers. And we know that's going to take time to develop and really quantify some of those impacts. In terms of pushback, today what we are seeing is a little bit what Jamie talked about.

其他一些功能，例如案例洞察、力回饋，我們很高興與客戶合作。我們知道這需要時間來發展並真正量化其中一些影響。就阻力而言，今天我們看到的是傑米談到的一些內容。

We are starting -- customers will have to evaluate the value of da Vinci 5. We have these early adopters that are excited about what it can be. And as we move in through our measured launch, we will continue to have to underscore, and reinforce the value that it brings, and communicate that to executives and their teams.

我們正在開始——客戶將不得不評估達文西 5 的價值。當我們進行有針對性的發佈時，我們將繼續強調並強化其帶來的價值，並將其傳達給高階主管及其團隊。

I'll just jump in and add a little. We expect to be evaluated against the quadruple or the quintuple aim with regard to DV5. And we are confident that we are going to get there. I think we are going to develop the data to support that perspective. The apples-to-apples price differences aren't that great once you add inflator, and some of the other things that are built in.

我就跳進去補充一點。我們期望針對 DV5 的四重或五重目標進行評估。我們有信心能夠實現這一目標。我認為我們將開發數據來支持這一觀點。一旦添加充氣機和其他一些內建的東西，同類產品之間的價格差異就不那麼大了。

We have just got to justify that difference. One of the questions I would ask, and Dave, you can answer it is, are there any procedures that physicians prefer using da Vinci 5 Xi to da Vinci 5? In other words, is there any preference to stay with what they have got?

我們必須證明這種差異是合理的。我要問的問題之一（戴夫，你可以回答）是，與達文西 5 相比，醫生是否更喜歡使用達文西 5 Xi 進行任何手術？換句話說，是否有任何偏好保留他們所擁有的東西？

Yeah. So, Gary, in all of my discussions and with the team, surgeons prefer the use of da Vinci 5 for the reasons we talked about.

是的。因此，Gary，在我和團隊的所有討論中，出於我們討論的原因，外科醫生更喜歡使用達文西 5。

So I think on the administrative side, as long as you can demonstrate that the quadruple aim or the quintuple aim is being satisfied, that they are getting value for the relatively modest apples-to-apples price increase, I think we feel pretty good. I would say on force reflection and on case insights, these are powerful foundational new capabilities that are going into the market. And I think that's really interesting.

因此，我認為在行政方面，只要你能夠證明四倍目標或五倍目標得到滿足，他們正在從相對溫和的同類價格上漲中獲得價值，我認為我們感覺很好。我想說的是，關於力量反思和案例洞察，這些都是正在進入市場的強大的基礎新功能。我認為這真的很有趣。

And we'll work with leading customers to start evaluating where do they make sense and where don't they. We of course believe that there are going to be procedures and patient populations where they make a ton of sense, and they generate real value. So early, it is about data generation and research and feedback. And later, we will start to drive that through clinical publications and other things.

我們將與主要客戶合作，開始評估他們的做法在哪些方面有意義，哪些方面沒有意義。我們當然相信，將會有一些程序和患者群體具有很大的意義，並且會產生真正的價值。這麼早，它是關於數據生成、研究和回饋。之後，我們將開始透過臨床出版物和其他事情來推動這一目標。

So I think there is a left hand, right hand here. Some of it is what you get today. You get precision, you get imaging, you get ergonomics, you get throughput. There are some things that in this platform, you get to participate in its research and development. That will come later.

所以我認為這裡有左手，右手。其中一些就是您今天得到的。您可以獲得精確度、成像效果、人體工學效果、吞吐量。在這個平台上，你可以參與一些東西的研發。那會稍後發生。

Then it is a core technology platform upon, which we can build. Jamie mentioned it earlier. So it is that set of sequences that gives us some confidence to keep pushing hard.

然後它是我們可以建立的核心技術平台。傑米之前提到過。因此，正是這組序列給了我們繼續努力的信心。

Well Gary, you anticipated my follow-up question. So let me ask another one here. One of the items of feedback I have heard from physicians is that case insights and the force sensing can help existing physicians be better. But more importantly, it could help physicians that do a lot of lab procedures or open procedures make it easier for them to adjust to robotics. Is that something you are hearing? I know it is early in the launch here, but how do you think about those features and the ability to get more conversion from lab to robotic?

好吧，加里，你預料到了我的後續問題。那麼讓我在這裡問另一個人。我從醫生那裡聽到的反饋之一是病例洞察和力感可以幫助現有醫生做得更好。但更重要的是，它可以幫助進行大量實驗室手術或開放性手術的醫生，讓他們更容易適應機器人技術。這是你聽到的嗎？我知道現在還處於發布初期，但您如何看待這些功能以及從實驗室到機器人的更多轉換的能力？

So, I do think there are several ways to consider force feedback and think about it. One of them is, we do think it can have an impact on learning curve. And so as laparoscopic surgeons or newer surgeons to the platform adopted, we believe that force feedback and looking at force feedback through case insights can improve their time to proficiency on the robot.

所以，我確實認為有幾種方法可以考慮力回饋並思考它。其中之一是，我們確實認為它會對學習曲線產生影響。因此，作為腹腔鏡外科醫生或新外科醫生所採用的平台，我們相信力回饋和透過案例洞察查看力回饋可以縮短他們熟練使用機器人的時間。

When it comes to longer term clinical outcomes and what force feedback and the data surrounding it, it's what Gary described. We believe it to be a powerful component of looking to the future and saying, how do we improve surgical outcomes? Does gentler surgery imparting less force on tissue have a difference in outcomes?

當涉及長期臨床結果以及力回饋及其相關數據時，這就是加里所描述的。我們相信它是展望未來並提出「我們如何改善手術結果」的強大組成部分？較溫和的手術對組織施加的力道較小，結果是否會有所不同？

Our hypothesis is strongly yes. And so that is what is going to take multiple quarters in time to develop. But I do believe there are two segments where force feedback can have that impact.

我們的假設是肯定的。因此，這將需要多個季度的時間才能實現。但我確實相信力回饋可以在兩個部分產生這種影響。

Thank you very much.

非常感謝。

David Roman, Goldman Sachs.

大衛羅曼，高盛。

Thank you and good afternoon, everybody. I wanted to start on an Ion question. Appreciating some of the supply chain dynamics that may have contributed positively to growth in the quarter. But maybe you could go into a little bit more detail about what you're seeing in the field from an adoption perspective, to what extent you're seeing higher diagnostic yields on Ion result in earlier intervention for patients, and whether those interventions are taking place utilizing da Vinci or not?

謝謝大家，大家下午好。我想從一個 Ion 問題開始。讚賞可能對本季成長做出積極貢獻的一些供應鏈動態。但也許您可以從採用的角度更詳細地了解您在該領域所看到的情況，您看到 Ion 的更高診斷率在多大程度上導致了對患者的早期幹預，以及這些幹預措施是否正在採取是否使用達文西的地方？

Yes, so with respect to getting a patient into the diagnostic pipeline, that's an independent variable from Ion and or da Vinci. And so that's through screening or incidental findings. But once they're in there, then Ion is offering really, really effective way to go and biopsy that lesion.

是的，所以就讓患者進入診斷流程而言，這是離子和/或達文西的獨立變數。這是透過篩選或偶然發現得出的。但一旦它們進入那裡，Ion 就會提供非常非常有效的方法來對病灶進行活檢。

And so, we look at two main variables there. One is the size of the lesion, and then one is the diagnostic yield. And so the important part of this is to diagnose smaller and smaller lesions. Now, the smaller the lesion, it is correlated to cancer stage. And that's where if you get it at stage 1A, you can have very, very high survival.

因此，我們關注兩個主要變數。一是病灶的大小，二是診斷率。因此，其中重要的部分是診斷越來越小的病變。現在，病灶越小，它與癌症分期相關。如果你在 1A 階段獲得它，你就能獲得非常非常高的生存率。

So we're pushing towards smaller lesion size. And then diagnostic yields that are as good as possible, approaching TTNA levels or CT guided biopsy levels, and eventually we hope to exceed those.

因此，我們正在努力縮小病灶尺寸。然後診斷率盡可能好，接近 TTNA 水平或 CT 引導活檢水平，最終我們希望超過這些水平。

And so those together, Ion is proving to be a really effective tool at doing that well, while maintaining an improved safety profile over CT guided needle biopsy. And so, when somebody is diagnosed with Ion and it is deemed to be cancer, then oftentimes they may move to a da Vinci procedure.

因此，事實證明，Ion 是一個真正有效的工具，可以很好地做到這一點，同時保持比 CT 引導穿刺活檢更高的安全性。因此，當某人被診斷出患有 Ion 並被認為是癌症時，他們通常可能會轉向達文西手術。

It's really up to the tumor board and that physician about the best way to treat that patient. It may be with da Vinci; it may be with radiation or some other alternative. So oftentimes they're coupled, but not all the time.

治療該患者的最佳方法實際上取決於腫瘤委員會和醫生。可能是達文西；可能是透過輻射或其他替代方法。所以他們經常是耦合的，但並非總是如此。

That's a very helpful context. Thank you. And maybe I could ask a financial question on the follow-up here. I think as I look at the operating expense targets for the year, most of the reduction actually looks like, it stems back to what might have been a slower start to the year.

這是一個非常有幫助的背景。謝謝。也許我可以在這裡問一個關於後續行動的財務問題。我認為，當我審視今年的營運費用目標時，大部分削減實際上看起來像是因為今年開局可能較慢。

I think you grew OpEx about 7% in Q1 and saw an acceleration here in Q2. But maybe you could just help unpack a little bit about -- a little bit of the dynamic underpinning the operating expense growth for the balance of the year. And how we should think about sort of normalized OpEx growth.

我認為第一季營運支出成長了約 7%，第二季有所加速。但也許你可以幫助解開一些關於今年剩餘時間營運費用成長的動態。以及我們應該如何考慮正常化的營運支出成長。

Is that the seven number where you started the year, the low double-digit number where you're trending now? And then I don't know if you're willing to offer any perspective on the incremental depreciation, but you were in like the $90 million range in Q1, $100 million range -- in Q1 of this year. Are we talking about a $10 million per quarter increase, $20 million? And any framing you give might be helpful on that side as well?

這是您今年開始時的七個數字，還是您現在的趨勢中較低的兩位數數字？然後我不知道您是否願意對增量折舊提出任何看法，但今年第一季的折舊額約為 9000 萬美元，1 億美元的範圍。我們談論的是每季增加 1000 萬美元還是 2000 萬美元？您提供的任何框架在這方面也可能有幫助嗎？

Yeah. Quarter to quarter, it can be a little lumpy depending on those expenses -- are not consistent across quarters. So I just say if you take the first half, OpEx grew 9%. And you look at the updated guidance, it says the second half grows 11% to 15%, 16%-ish. So an acceleration in the second half.

是的。每個季度的情況可能會有些不穩定，具體取決於這些費用——各個季度的費用並不一致。所以我只是說，如果你看上半年，營運支出成長了 9%。你看看更新後的指導，它說下半年成長 11% 到 15%，16% 左右。所以下半場加速了。

From a framing perspective, roughly we're looking to maintain R&D about revenue growth, and it's been at 11% last couple of years. The first half is about 11%. And then you've seen us describe how we've been leveraging enabling functions.

從框架的角度來看，我們大致希望維持營收成長的研發，過去幾年一直維持在 11%。上半年約為11%。然後您已經看到我們描述了我們如何利用支援功能。

In terms of then what the OpEx guidance was on the last call versus what it is today, there are some of those lumpy expenses that are no longer in the year just, because of timing. We have looked at some headcount that we had planned for the year that we've pushed into 2025. That's really around focus, not around anything other than focus.

就上次電話會議時的營運支出指導與今天的指導相比，由於時間原因，其中一些巨額支出不再包含在今年內。我們已經研究了我們為 2025 年計劃的一些員工人數。

Where you see opportunities to continue to leverage maybe at greater rates than we expected, then we'll realize those efficiency benefits. But we do expect second-half operating expenses to be higher than the first half. And that's primarily driven by depreciation. Not ready to be specific about what the relative increase in depreciation expense is, but it is contemplated in that ramp up in second half operating expenses.

如果您看到繼續以比我們預期更高的速度利用槓桿的機會，那麼我們將實現這些效率優勢。但我們確實預計下半年營運費用將高於上半年。這主要是由折舊驅動的。尚未準備好具體說明折舊費用的相對增長是多少，但預計下半年營運費用會增加。

Great. Thank you very much.

偉大的。非常感謝。

Rick Wise, Stifel.

瑞克懷斯，史蒂菲爾。

Good afternoon, everybody. Hi, Gary. Hi, Dave. Just -- I was hoping that you could talk a little bit more about the procedure growth outlook broadly. You gave us -- you bumped up the range, and we're very clear about the low-end factors at the low and the high end.

大家下午好。嗨，加里。嗨，戴夫。只是——我希望你能更廣泛地談論一下手術增長的前景。你給了我們——你提高了範圍，我們非常清楚低端和高端的低端因素。

But I was just curious, I'm not sure I understand from your perspective. Is our bariatric or GLP-1 pressure is leveling off here? Or have they leveled off? How reasonable is it to think you could get to the upper end? And the same question for the China Asia pressures you talked about as well. Could you just elaborate a little bit on that? Thank you.

但我只是好奇，我不確定我是否從你的角度理解了。我們的減重壓力或 GLP-1 壓力是否已趨於平穩？或者他們已經趨於平穩了嗎？認為自己能夠達到頂峰的合理性如何？對於您談到的中國亞洲壓力，也是同樣的問題。能詳細說明一下嗎？謝謝。

Yeah. With regard to how to think about the range, I'm going to ask Brian to step in and do that. So Brian, do that, and then we'll come back to talk a little bit about GLP-1s and I'll perhaps take that. And then I think on China, I'll take it to Dave.

是的。關於如何考慮範圍，我將請布萊恩介入並這樣做。所以，Brian，這樣做，然後我們會回來討論一些有關 GLP-1 的問題，我也許會接受。然後我想到中國，我會把它交給戴夫。

So Rick, I'm just going to reemphasize or restate what the range was. So just ramp size 15.5% to 17% is procedure guidance for the year. At the low end, we're assuming that bariatric procedures continue to soften.

所以里克，我只是要再次強調或重申範圍。因此，今年的程序指導僅是將坡道尺寸提高 15.5% 至 17%。在低端，我們假設減重手術繼續軟化。

We did talk a bit about even last quarter and this quarter in Asia around physician strikes that were impacting procedures in Korea along with delayed tenders, impacting procedure or capital placements in China, which, therefore, impacts overall procedures, or procedure growth.

我們確實討論了上個季度和本季在亞洲的醫生罷工問題，這些罷工影響了韓國的手術，以及延遲的招標，影響了中國的手術或資本配置，因此影響了整體手術或手術增長。

And at the high end of the range, we're really assuming that bariatric essentially stabilizes at current quarter rates. And again, that Korea and China do not get any worse.

在該範圍的高端，我們確實假設肥胖治療基本上穩定在當前季度的水平。再次強調，韓國和中國不會變得更糟。

Yeah. Speaking of bariatrics, two effects are going on. The GLP-1s are changing to the surgical market. And even within that, there is some share change between laparoscopy and robotics that's going on. So you have two things that are coming through, and they net out. It is not -- the impact of GLP-1s on the bariatric surgery market from our perspective in aggregate has not bottomed yet.

是的。說到減肥，有兩種影響正在發生。 GLP-1 正在轉向外科市場。即便如此，腹腔鏡檢查和機器人技術之間的份額也正在發生一些變化。所以你有兩件事正在發生，然後它們就消失了。事實並非如此——從我們的整體角度來看，GLP-1 對減重手術市場的影響尚未見底。

And the reality is I don't think anybody knows when and where that will exactly settle for a couple of reasons. I think some of it is looking at the puts and takes of effectiveness. And you have constrained access to the drugs, and you have some new drugs in the pipeline. So that will play out over time. And if somebody told you they knew the answer, I'm not sure I believe them.

現實情況是，我認為沒有人知道這件事會在何時何地得到解決，原因有幾個。我認為其中一些是著眼於有效性的投入和收穫。而且藥物的取得受到限制，而且還有一些新藥物正在研發中。所以這會隨著時間的推移而發揮作用。如果有人告訴你他們知道答案，我不確定我是否相信他們。

Having said all that, we're not depressed about it. I think that it will play out. I think there's a role for bariatric surgery, and I think in our customers' hands with our systems, that surgery has done well. So we're just going to have to all go through it together. I think we're going to look that experience together. With regard to kind of longer-term outlook of procedures in China and overall sentiment. Dave, I'll kick to you.

話雖如此，我們並不為此感到沮喪。我認為它會發揮作用。我認為減肥手術可以發揮作用，而且我認為在我們的客戶手中使用我們的系統，手術效果很好。所以我們必須一起經歷這一切。我想我們會一起回顧這段經歷。關於中國程序的長期前景和整體情緒。戴夫，我會踢你的。

Yeah. What I would say about the longer-term outlook here is our offerings, when I said before, are highly valued in China. The systems are utilized at a high clip. And there's value that surgeons and patients place on high-quality, minimally invasive care. And so that's the draw of this.

是的。關於長期前景，我想說的是，正如我之前所說，我們的產品在中國受到高度重視。該系統的利用率很高。外科醫生和患者都非常重視高品質的微創護理。這就是它的吸引力。

In terms of some of the headwinds and to me, there are two areas. One is the capital environment that we talked about. And with constrained capital environment and placements, it has an impact on procedure growth.

就我而言，就一些不利因素而言，有兩個面向。一是我們講的資本環境。並且由於資本環境和配售的限制，對流程的成長產生了影響。

And then, there's other areas around this rebasing by the government around economics. And so, it has various impacts. It can have impacts in provinces around charge codes and that is another headwind for us in terms of procedure growth and utilization long term.

然後，政府圍繞經濟重新調整基礎還有其他領域。因此，它具有各種影響。它可能會對收費代碼周圍的省份產生影響，這對我們的流程成長和長期利用而言是另一個阻力。

Two comments I'd make on both the headwinds. I think at some point, I'd expect both of them to be time limited. I think there'll be an equilibrium that will be found between GLP-1s and surgery at some point. I also feel like the rebase line in -- the economic rebase line in China and the integration and emergence of domestic systems. But those things will start to find an equilibrium also.

我對這兩種不利因素發表兩點評論。我認為在某些時候，我希望它們都會受到時間限制。我認為 GLP-1 和手術之間在某個時刻將會達到平衡。我也感覺像是中國的經濟重新基準以及國內體系的整合和出現。但這些事情也將開始找到平衡。

How long is that going to take, is I think what's underlying this question and the answer is we don't know. But I think that minimally invasive surgery in China is highly valued. There's a belief in robotic-assisted surgery as being important. And our products and ecosystem is valued. So I think that we're enthusiastic about completing that.

我認為這個問題的根本原因是什麼，這需要多長時間，而答案是我們不知道。但我認為微創手術在中國是受到高度重視的。人們相信機器人輔助手術很重要。我們的產品和生態系統很有價值。所以我認為我們對完成這個任務充滿熱情。

Yeah. Gary, if I could just one follow-up. The question I have gotten most frequently post the launch of DV5 is what new procedure -- what new incremental TAM will da Vinci 5 unlock? I had the privilege of interviewing Dave, who might be near at hand today, that question at SRS. And I said the way da Vinci 5 unlock the general surgery TAM, what will da Vinci 5 unlock, and Dave very eloquently said it's going to unlock the routine use of robotic surgery every day.

是的。加里，請讓我跟進。在 DV5 推出後，我最常被問到的問題是，達文西 5 將解鎖什麼新程式——什麼新的增量 TAM？我有幸採訪了戴夫，他今天可能在 SRS 上就這個問題進行了採訪。而我說達文西5解鎖一般外科TAM的方式，達文西5會解鎖什麼，戴夫非常雄辯地說它將解鎖每天機器人手術的常規使用。

Do you agree with Dave? And is that -- are your customers understanding that vision or getting that that's what you're aiming at just any reaction to those thoughts, I'd appreciate it? Thank you, Dave.

你同意戴夫的觀點嗎？您的客戶是否理解您的願景或實現您的目標？謝謝你，戴夫。

You're welcome, Rick.

不客氣，瑞克。

Yeah. I'll start. Good you asked. Yeah, I agree with him. No shock. Maybe just to reiterate our position. There's two different ways that it can help grow long-term. One way is to go deeper into the procedure base, we're in already to help care teams and physicians who have thus far not wanted to adopt or have chosen not to adopt, or have had a barrier to adoption, to help them adopt.

是的。我開始吧。好你問了。是的，我同意他的觀點。沒有震驚。也許只是為了重申我們的立場。有兩種不同的方式可以幫助長期成長。一種方法是更深入地了解程序基礎，我們已經在幫助迄今為止不想收養或選擇不收養或在收養方面存在障礙的護理團隊和醫生，以幫助他們收養。

And that can be through some of the functionality of DV5 and what it does, a little bit of easier access to other capital for example, of Xis become more used in more places. It can release access constraints together as a portfolio. Those are powerful things, and that speaks to what Dave spoke about.

這可以透過 DV5 的一些功能及其作用來實現，例如更容易獲得其他資本，Xi 在更多地方得到更多使用。它可以作為一個組合來釋放存取限制。這些都是強大的東西，這符合戴夫所說的內容。

We don't think we're done getting additional indications on DV5. And those are things that could happen in the future. And as we get closer and see what those opportunities are, we'll describe them.

我們認為我們還沒有完成有關 DV5 的更多指示。這些都是未來可能會發生的事。當我們越來越接近並了解這些機會是什麼時，我們將描述它們。

Thank you.

謝謝。

Drew Ranieri, Morgan Stanley.

德魯‧拉涅利，摩根士丹利。

Hi, thanks for taking the questions. Maybe just something that we also heard from SRS was that the DV -- da Vinci Xi is still very well considered in the field and there are surgeons that still want to get their hands on it. So just can you talk a little bit more about some of the underlying demand for Xi in the US?

您好，感謝您提出問題。也許我們也從 SRS 聽到的是，DV - da Vinci Xi 在該領域仍然得到了很好的考慮，並且仍然有外科醫生希望得到它。那麼您能否多談談美國對習近平的一些潛在需求？

And Jamie, I think you pointed out too, that you kind of expect DV5 to sequentially improve throughout the year. So maybe just talk to us about what that means for Xi, given that you're having broader conversations with hospital administrators and surgeons as they're thinking about building capacity for robotic surgery?

Jamie，我想您也指出過，您希望 DV5 在全年不斷改進。那麼，考慮到您正在與醫院管理人員和外科醫生進行更廣泛的對話，因為他們正在考慮建造機器人手術的能力，也許您可以跟我們談談這對習近平意味著什麼？

Yeah. I would just say in the US, demand for Xi kind of has two segments to it. You have customers that need incremental capacity. Da Vinci 5 isn't available in the time that they need it. And so they're entering into arrangements with us to take Xi now to serve that expansion of capacity they need.

是的。我只想說，在美國，習近平的需求有兩個部分。您的客戶需要增加容量。 Da Vinci 5 在他們需要的時候無法使用。因此，他們正在與我們達成協議，讓習近平現在為他們所需的產能擴張服務。

And then they have the upgrade right built into the arrangement to move to da Vinci 5 when it becomes available likely in broad launch. You have another segment of customers in the US who are kind of wait and see with respect to, what the value will be of da Vinci 5. And again, they look for building evidence and a broadening of customer belief.

然後，當達文西 5 可能廣泛發佈時，他們就會將升級權內建到遷移到達文西 5 的安排中。美國還有另一部分客戶，他們對達文西 5 的價值持觀望態度。

And part of that consideration is the profile of that customer, what their strategy is, what their procedure mix is. And of course, as part of the consideration, they're looking at the incremental price, which as Gary described, when you do the full stack isn't actually that significant.

其中一部分考慮因素是該客戶的概況、他們的策略是什麼、他們的程序組合是什麼。當然，作為考慮的一部分，他們正在考慮增量價格，正如加里所描述的，當你做完整的堆疊時，增量價格實際上並不那麼重要。

But those customers that have tight capital budgets who like Xi, which is a capable system are more a wait and see. So I think in terms of -- as you look forward, that will evolve with respect to how da Vinci capacity expands, and the extent to which then more customers can take that system. But there is a segment of customers that really like Xi.

但那些資本預算緊張、喜歡 Xi 這個強大系統的客戶更多的是觀望。因此，我認為，正如您所期望的那樣，這將隨著達文西產能的擴展以及更多客戶可以使用該系統的程度而發展。但有一部分顧客真的很喜歡習近平。

And has there been any change in thinking about bringing da Vinci 5, to the broader global markets, I know that you're working on a couple of regulatory filings right now, but any update on timing or further market expansion? Thanks for taking the questions.

關於將達文西 5 推向更廣泛的全球市場的想法是否有任何變化？ 我知道您現在正在處理幾份監管文件，但關於時間安排或進一步市場擴張的任何更新嗎？感謝您提出問題。

Yeah. Just in terms of our OUS plans, I think it's consistent with what we have communicated, which is -- we're in discussions with Korea and Japan and don't expect to launch in Europe, before the end of next year. And so as we look beyond that, it's just too early to detail out those plans, and we'll let you know as they get a little bit more into focus here.

是的。就我們的 OUS 計劃而言，我認為這與我們所傳達的內容是一致的，即我們正在與韓國和日本進行討論，預計明年年底之前不會在歐洲推出。因此，當我們超越這一點時，現在詳細說明這些計劃還為時過早，當它們在這裡得到更多關注時，我們會讓您知道。

Adam Maeder, Piper Sandler.

亞當梅德，派珀桑德勒。

Hi. Good afternoon. Thank you for taking the questions and congrats on the nice quarter. Two from me. The first one is on DV5, and I specifically wanted to ask about the hardware and software changes that you plan to make, in the back half of the year.

你好。午安.感謝您提出問題，並祝賀您度過了美好的季度。我的兩個。第一個是關於 DV5 的，我特別想問你們計劃在下半年進行的硬體和軟體更改。

What are you hoping to improve upon? What is the magnitude of the changes that you plan to implement? It sounds like they're relatively minor but wanted to confirm that. And then I had a follow-up? Thank you.

您希望在哪些方面進行改進？您計劃實施的變革的規模有多大？聽起來它們相對較小，但想確認一下。然後我有後續行動？謝謝。

Sure. I'll take that. So some of the near-term additions that we're talking about include the integration of hub capabilities of Intuitive Hub. And then from the surgeon having this head-end experience, when they're in the console, they'll be able to start accessing and controlling Intuitive 3D models, being able to manipulate them from the console with the controls there.

當然。我會接受的。因此，我們正在討論的一些近期新增內容包括 Intuitive Hub 的集線器功能的整合。然後，擁有這種前端經驗的外科醫生，當他們在控制台中時，他們將能夠開始存取和控制直觀的 3D 模型，並能夠透過控制台上的控制項來操縱它們。

And also, they'll have the ability to access and replay intraoperative video. And then we'll also include and integrate in simulation. So that gives you a flavor, I think, of some of the pieces that we're adding that we've talked about in these hardware and software upgrades.

此外，他們還能夠存取和重播術中影片。然後我們還將包含並整合到模擬中。我認為，這讓您對我們在這些硬體和軟體升級中討論過的添加的一些內容有了一些了解。

In addition, there will be some software upgrades that include responding to customer feedback as well. And some of the things that we've heard as we're going through our measured launch here.

此外，還將進行一些軟體升級，包括回應客戶回饋。以及我們在此處進行測量發佈時聽到的一些事情。

And then if you look a little further out, some intraoperative technology building blocks that we're working on, such as procedure step mapping, and 3D depth mapping that will use some AI and ML algorithms and leverage this compute power of da Vinci 5. And those things will set us up for some more advanced features in the future that leverage that foundation.

然後，如果您看得更遠一些，我們正在開發一些術中技術構建模組，例如手術步驟映射和 3D 深度映射，它們將使用一些 AI 和 ML 演算法並利用 da Vinci 5 的計算能力。我們在未來利用這項基礎提供一些更進階的功能。

Highly good color, Dave. Thank you for that and for the follow-up. Wanted to ask about SP. Congrats on the thoracic indication. I'm curious how much you think that expands the opportunity for SP here in the states. I know you're also working on cold erectile, so curious if you have timelines there? And then together, does that kind of give you the indication base to push SP more aggressively in the US? Thanks for taking the questions.

戴夫，色彩非常好。感謝您的關注和後續行動。想問一下SP的事。恭喜獲得胸部指徵。我很好奇你認為這會在多大程度上擴大 SP 在美國的機會。我知道您也在研究冷勃起，所以我很好奇您是否有時間表？那麼，這是否為您提供了在美國更積極地推動 SP 的指示基礎？感謝您提出問題。

Yeah. In terms of thoracic, in the early period, that procedure actually is optimal when you have a stapler and we're in development for a stapler for SP. And so, we'll be able to work with early adopters on the thoracic indication. But it's really when the stapler comes that you're able to more robustly drive adoption. One of the advantages of SP is, of course then the opportunity to access the body in ways that, does less damage to healthy tissue.

是的。就胸部而言，在早期，當您有吻合器時，該手術實際上是最佳的，並且我們正在開發用於 SP 的吻合器。因此，我們將能夠與早期採用者合作研究胸部適應症。但只有當訂書機出現時，您才能夠更有力地推動採用。當然，SP 的優點之一是有機會以對健康組織損傷較小的方式進入身體。

Today in the US, in terms of thoracic for multiple, we're already relatively highly penetrated. And so really the question then is relative value of SP compared to Xi. What was the second part of your question? I'm sorry, if you could repeat it?

今天在美國，就胸腔多發性而言，我們已經相對高度滲透。因此，真正的問題是 SP 與 Xi 相比的相對價值。你問題的第二部分是什麼？抱歉，您能再說一次嗎？

Yes, happy to. I was just asking about colorectal timing. I think you have the IDE study that's ongoing. And I think that will be your fourth indication once the colorectal indication is in hand. So does that kind of give you critical mass from an indication standpoint to push more aggressively with SP in the US?

是的，很高興。我只是想問一下結直腸時間。我認為您正在進行 IDE 研究。我認為一旦掌握了結直腸指徵，這將是您的第四個指徵。那麼，從指示的角度來看，這是否為您提供了在美國更積極地推動 SP 的臨界質量？

Yeah. The work on the IDE has progressed. We don't have any additional detail at this point. And obviously, that then adds another category with respect to the set of indications in the US. And I think it does have -- give us the opportunity to both supplement SP procedure growth in the US.

是的。 IDE 的工作已經取得進展。目前我們沒有任何其他細節。顯然，這又為美國的一組適應症增加了另一個類別。我認為它確實給了我們機會來補充美國 SP 程序的成長。

And add to the growing utilization we see of the SP platform in the US, but I think we also have the opportunity for additional indications over time in the US. Colorectal like thoracic will also require the SP stapler.

我們看到美國 SP 平台的使用率不斷增長，但我認為隨著時間的推移，我們也有機會在美國獲得更多跡象。大腸直腸如胸部也需要 SP 吻合器。

Operator, we'll take one more question from one more call and then we'll wrap.

接線員，我們將再接聽一通電話中的一個問題，然後結束。

Richard Newitter, Truist Securities.

理查德紐特 (Richard Newitter)，Truist 證券公司。

Thanks for taking the question. Maybe for Jamie, just Jamie in the past, you've talked about a long-term or an intermediate to long-term three, four-year time frame to get back above sustainably 70% gross margin. A, correct me if that's not true, but I'm pretty sure that's what you've said in the past.

感謝您提出問題。也許對 Jamie 來說，只是 Jamie 過去，您談到了長期或中長期的三四年時間框架，以可持續地恢復到 70% 以上的毛利率。答，如果這不正確，請糾正我，但我很確定這就是您過去所說的。

I'm just curious just with some of the initiatives maybe paying dividends earlier than expected and faster. I know you have some manufacturing transition going on for Ion disposables. That's a big initiative. Is it possible we're moving towards that goal a little faster sooner? I'd love to hear any thoughts there.

我只是好奇一些措施可能會比預期更早、更快地支付紅利。我知道你們正在對 Ion 一次性用品進行一些生產轉型。這是一個很大的舉措。我們是否有可能更快地朝著這個目標邁進？我很想聽聽那裡的任何想法。

Specifically, 70% gross margin, that's not sustainable in the shorter term. It continues to be our aspiration to have gross margin at 70% in the medium term. There's work for us to do over that period with respect to obviously da Vince costs.

具體來說，70%的毛利率在短期內是不可持續的。我們仍然希望中期毛利率達到 70%。在那段時間裡，我們在達文斯的成本方面還有很多工作要做。

We have to continue to progress on Ion and SP costs. And as we've said, we have incremental depreciation in the second half and more significant incremental depreciation next year. And so that will also require us to then manufacturing capacity related, which you build in chunks.

我們必須繼續在離子和 SP 成本方面取得進展。正如我們所說，下半年我們將進行增量折舊，明年將進行更大幅度的增量折舊。因此，這也需要我們分批建立相關的製造能力。

We'll have to revenue leverage that incremental depreciation over a period of time. Certainly, in terms of the baseline of where we are at, the cost reductions we described on component costs, and logistic costs have come in a little earlier. And that's why we've raised the guidance, for gross margin for this year. But the aspiration for 70% gross margin is still a medium-term aspiration.

我們必須在一段時間內利用增量折舊來增加收入。當然，就我們所處的基準而言，我們描述的零件成本和物流成本的成本降低已經出現得更早了一些。這就是我們今年提高毛利率指引的原因。但70%毛利率的目標仍是中期目標。

I'll wrap it there. Thank you. That was our last question. In closing, we believe that there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians, and care teams in pursuit of what our customers have now termed the quintupling, better -- more predictable patient outcomes, better experiences for patients, better experiences for their care teams, better access to great care and ultimately, a lower total cost of care.

我會把它包在那裡。謝謝。這是我們最後一個問題。最後，我們相信存在大量且持久的機會從根本上改善手術和緊急幹預措施。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求客戶現在所說的五倍增長、更好——更可預測的患者結果、更好的患者體驗、更好的護理團隊體驗、更好地獲得優質服務。

We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and care teams, their needs and their environment. At Intuitive, we envision the future of care that is less invasive and profoundly better where diseases are identified earlier and treated quickly so patients can get back to what matters most. Thank you for your support on this extraordinary journey. We look forward to talking to you again in three months.

我們相信手術和急診護理中的價值創造本質上是人的。它源自於對病人和照護團隊、他們的需求和環境的尊重和理解。在 Intuitive，我們設想未來的護理將是侵入性更小、效果更好的護理，能夠更早發現疾病并快速治療，以便患者能夠回到最重要的事情上。感謝您對這段非凡旅程的支持。我們期待三個月後再次與您交談。

Thank you, everyone, for joining today's conference call. You may now disconnect at this time. Have a good day.

感謝大家參加今天的電話會議。您現在可以斷開連線。祝你有美好的一天。